Client safety information and medical form

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Your Full Name *

Email *

Mobile phone number *

Date of birth *

Town where you live (or nearest one)? *

Emergency contact name *

Emergency contact number

If you are hiring kayak/kit please tell me your approx height and weight

Please list any relevant medical issues that may affect your time on the water (copy) *

If none please write none

If you carry any medicine, where do you keep it? *

If none please write none

Are you happy for your mobile number to be included in a WhatsApp group for ease of information sharing related to this trip? *

Yes I am happy with this
No thanks prefer email / I don't use whatsapp

Privacy: Are you happy for photos, videos taken on the trip in which you appear to be used within promotional material on paper and online including social media. *

Yes I am happy with this
No thanks

DISCLAIMER Sea kayaking and its associated activities, carries risk of injury and in very rare cases, death. I declare, I am fit and healthy, to the best of my knowledge to take part in sea kayaking activities, and I have declared above any relevant medical information. *

Please read and add your initials to the box

Are you happy to receive occasional marketing email from me? *

Yes I am happy with this
No thanks.